EBCOG – PART 1 – EARLY PREGNANCY – DAY 1 (EMQ)

A: Dilatation of the cervix and uterine curettage
B: Hysterectomy and bilateral salpingo-oophorectomy
C: Intramuscular methotrexate and folinic acid
D: Intravenous multiagent chemotherapy
E: Measure serum hCG 6–8 weeks after the pregnancy
F: Medical termination of pregnancy
G: Oxytocin infusion to stop uterine haemorrhage prior to suction evacuation of the uterus
H: Prenatal invasive testing for foetal karyotype
I: Prostaglandin cervical ripening prior to suction evacuation of the uterus
J: Second suction evacuation of the uterus
K: Suction evacuation of the uterus
L: Suction evacuation of the uterus and insertion of Mirena intrauterine delivery system
M: Suction evacuation of the uterus and postoperative anti-D prophylaxis
N -Tests and treatment not required

It can be assumed that in each case the woman has been registered with the nearest Trophoblastic Screening and Treatment Centre The above options show various testament for molar pregnancy . For the following women chose the appropriate  management ,each option cane be use once more than once or none at all.

1.Mrs, Reshma .A 28-year-old woman had a surgical evacuation of the uterus for an incomplete spontaneous miscarriage 3 months ago and the histology confirmed a molar pregnancy. She has had irregular vaginal bleeding since the procedure with episodes of dyspnoea and haemoptysis. Investigation results are as follows:

• full blood count: haemoglobin 9.6 g/l, otherwise normal
• liver and renal function tests: normal
• blood group: A Rh positive
• serum hCG: 98 457 IU/l; CA125: 275 U/l; AFP: 24 u/l; TSH: 1.4 mU/l
• pelvic ultrasound scan: 4.5-cm intrauterine lesion ? polyp; bilateral ovarian enlargement with multiple small cysts in both ovaries (6 cm and 7 cm maximum diameters); no free fluid
• CXR: three parenchymal nodules ranging from 1.0–2.5 cm in left upper lobe; heart size normal; no hilar enlargement
• MRI scan: no evidence of other metastatic lesions

2.Mrs,shagufta , A 34-year-old woman, P3, presents with some vaginal bleeding at 12 weeks of gestation and a pelvic On examination the uterus is palpated at the level of the umbilicus; Usg image is enclosed

 Investigation results are as follows:

• full blood count: haemoglobin 9.2 g/l, otherwise normal
• Liver and renal function tests normal
• blood group: AB Rh positive
• serum hCG: 14845IU/l; TSH: 3.1 mU/l

3.A 24-year-old nulliparous woman presents with some vaginal bleeding at 10 weeks of gestation and a pelvic ultrasound scan image enclosed

On examination the uterus is 14-week sized; the cervix looks normal and is closed; there is fresh blood and clots in the vaginal. Investigation results are as follows:

• full blood count: haemoglobin 10.2 g/l, otherwise normal
• liver and renal function tests: normal
• blood group: AB Rh negative
• serum hCG: 148 457 iu/l; TSH: 1.9 mU/l
  
  

4.Mrs. Deepa ,A 27-year-old woman, P1, presents with heavy vaginal bleeding and crampy period-like pains at 10 weeks of gestation. On examination she looks pale; BP: 100/60 mmHg; pulse rate: 104 bpm; the uterus is 14-week sized; the cervix is open and  She has got what she passed  at home .imag is enclosed

Investigation results are as follows:

• full blood count: haemoglobin 7.9 g/l, otherwise normal
• blood group: O Rh positive

5.A 41-year-old woman has a surgical evacuation of the uterus for an incomplete spontaneous miscarriage in her first pregnancy 6 months ago and the histology showed a molar pregnancy. She has had irregular vaginal bleeding since the procedure with no other symptoms. Investigation results are as follows:

• full blood count: haemoglobin 10.6 g/l, otherwise normal
• liver and renal function tests: normal
• blood group: A Rh negative
• serum hCG: 488 457 IU/l; CA125: 121 U/l
• thyroid function tests: normal
• pelvic ultrasound scan: 5.5-cm intrauterine lesion ? polyp; bilateral ovarian enlargement with multiple small cysts in both ovaries (6-cm and 7-cm maximum diameters); no free fluid
• CXR: normal
• MRI scan: no evidence of metastatic lesions